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2006

By Caroline Clauss-Ehlers

Chapter 12
Child Abuse and Resilience

Child Abuse: A Problem of National Scope
Child abuse is a problem of national scope with far reaching consequences. According to the U.S. Department of Health and Human Services Administration for Children and Families (n.d.), 1,800,000 referrals alleging child abuse and neglect were reported to child protective services (CPS) in 2002. 896,000 of these reports reflected abuse. 60% of the reports indicated neglect by parents and/or caregivers, 20% involved physical abuse, 10% involved sexual abuse, and 7% involved emotional maltreatment. Almost 20% of the reports were associated with other types of maltreatment (i.e., the fact that a child can experience more than one type of abuse).

More than 80% of the perpetrators of abuse and neglect were parents, 7% were other relatives, and 3% were unmarried partners. The rest were people with other roles (i.e., school personnel) or those whose relationship was unknown. Educators made 16.1% of all reports of abuse and neglect to CPS agencies (U.S. Department of Health and Human Services Administration for Children and Families, n.d.).

Younger children are most at risk for abuse. Children from the ages of 0 to 3 have the highest rates of abuse. 16 out of every 1,000 children within this age range are abused, with girls being more maltreated than boys. In 2002, 1,400 children died from child abuse or neglect. Of these fatalities, 75% involved children who were under 4 years of age, 12% were children between the ages of 4 to 7, 6% between 8 and 11 years of age, and 6% between 12 to 17 years of age.

Infant boys under the age of 1 have the highest fatality rates. 19 out of 100,000 boys and 12 out of 100,000 girls under age 1 die from abuse. Neglect, physical, and sexual abuse all contribute to these deaths (U.S. Department of Health and Human Services Administration for Children and Families, n.d.).

The definition of abuse involves defining different types of maltreatment. Complete Diversity Training Activity 12.1, Understanding Different Types of Abuse, at this point in your reading. This activity will help you explore the full meaning of the term child abuse. Through this exercise you will learn what is meant by physical abuse, sexual abuse, neglect, and emotional and psychological abuse. Although these broad categories of abuse exist, to date there is little consensus about how to define abuse. Conceptual differences about how to define abuse make it difficult to prove and document its existence. As a result, it is likely that the prevalence of abuse is underreported and much higher than indicated.

As a mandated reporter, your job is to report the indicators of abuse that you observe (See Mandated Reporting, this chapter). To perform this task it is critical that you are familiar with the general definitions and warning signs associated with the different types of abuse. Under the law, an abused child is a child under the age of 18 whose "parent or other person legally responsible for the child's care inflicts or allows to be inflicted upon the child physical injury by other than accidental means which causes or creates substantial risk of death or serious disfigurement, or impairment of physical health, or loss or impairment of the function of any bodily organ. It is also considered abuse if such a caretaker creates or allows to be created situations whereby a child is likely to be in risk of the dangers mentioned above" (Safe Child Program, n.d.).

Physical abuse of children is abusive behavior that involves physical maltreatment of a child by a caretaker. Physical abuse is indicated by bite marks, unusual bruises, burns, lacerations, frequent injuries or "accidents," fractures in unusual places, discoloration of the skin, beatings, shaking, strangulation, brain damage, and swelling to the face and extremities (Safe Child Program, n.d.).

Sexual abuse is "any sexual contact with a child or the use of a child for the sexual pleasure of someone else" (Safe Child Program, n.d.). Sexual abuse is perhaps one of the most taboo forms of abuse. As such, it is often underreported. It is important to consider sexual abuse on a continuum of behaviors. We tend to think of sexual abuse as involving sexual intercourse but this is only one type of sexually abusive behavior. Other behaviors include fondling of the genitals or asking the child to fondle the genital area, exposing private parts to the child, asking a child to expose him or herself, attempts to enter the vagina or anus with fingers or objects, pornography, prostitution, and voyeurism.

Neglect of children is broadly defined as behaviors by a caregiver that do not provide the child with the basic care necessary for adequate growth and development (Safe Child Program, n.d.). Neglect can include not providing medical care, mental health services, food, shelter, and education. Neglect also occurs when the caregiver does not provide the child with adequate supervision and proper safety. This includes situations where the caregiver is under the influence of alcohol or drugs that lead to impaired judgment and inadequate supervision.

Emotional and psychological abuse of children refers to any abuse that attempts to decrease the child's self-esteem and/or attempts to inflict fear through intimidation.

Emotional/psychological abuse is directly aimed at undermining the child's emotional development (Safe Child Program, n.d.). Emotional/psychological abuse includes aggressive, unrealistic demands on the child in the form of impractical expectations and pressure, putting the child down and continually attacking feelings of self-worth. Not following through with verbal promises is another aspect of emotional abuse that fosters disappointment, a lack of trust, and interferes with the ability to develop a healthy dependence.

Physical, Observable, and Behavioral Indicators of the Different Forms of Child Abuse
Research has amply documented the extensive negative effects of child abuse and neglect. These abuses can have physical, psychological, and behavioral consequences that extend over a lifetime. Abusive behaviors can repeat themselves when children who are abused become parents who mistreat their children.

Physical abuse. Physical consequences of child abuse include altered brain development in infancy and early childhood, poor physical health, and long-term health problems such as heart disease, cancer, lung disease, sexually transmitted disease, liver disease, and skeletal fractures (Felitti et al., 1998; Hart, Gunnar, Cicchetti, 1996). Problems like shaken baby syndrome where the infant is shaken too hard can result in blindness, mental retardation, cerebral palsy, learning disabilities, or paralysis (Conway, 1998).

Behavioral indicators of physical abuse include a child who has no contact with others, suffers from poor self-image, and is unable to trust or love. The child may demonstrate aggressive behavior, display rage, be self-destructive, or engage in passive behavior (Safe Child Program, n.d.). The child may fear entering new relationships or activities. In addition, the child may become apprehensive when other children cry, wear clothing that hides injuries, be secretive and offer inconsistent information about injuries, refuse to undress for gym or for a medical examination for fear that the injury will be exposed, give inconsistent information about how injuries occurred, be afraid of his parents, have frequent absences from school, report abuse by parents, run away from home, be withdrawn, and complain of body aches (Safe Child Program, n.d.). Adolescents may have problems at school, suffer from depression, and experience flashbacks or nightmares similar to symptoms associated with posttraumatic stress disorder (PTSD). They may abuse drugs or alcohol.

Sexual abuse. Physical indicators of sexual abuse include trouble walking or sitting, torn clothing, stained or bloody underwear, pain or itching in the genital area, venereal disease, and pregnancy (Safe Child Program, n.d.). Behavioral indicators of sexual abuse include the child who has either an unusual interest in or an avoidance of things of a sexual nature. The child may experience symptoms of post-traumatic stress, engage in seductive behavior, suffer from depression, feel that one's body is dirty or damaged, refuse to go to school, experience decreased self-esteem, exhibit feelings of worthlessness, display an abnormal or distorted view of self, and be suicidal (Safe Child Program, n.d.).

Youth who have experienced sexual abuse may be very secretive, indicate sexual molestation in drawings, engage in delinquent conduct, and be unusually aggressive. The child may demonstrate a sudden hesitancy to go someplace with someone, act out sexually, use new sexual terms, refuse usual family affection, demonstrate regressive behaviors such as thumb sucking or bedwetting, show signs of fearfulness, clinginess, and changes in personality (Safe Child Program, n.d.).

Neglect. Indicators of neglect vary according to the child's developmental stage. In the very early years, neglected infants and toddlers may be unresponsive to their surroundings. They may not exhibit behaviors that are generally expected for their developmental stage such as smiling, laughing, crying, and reacting to others in general. Neglected infants and toddlers are often not curious about their world. Neglected toddlers may engage in behaviors that reflect earlier stages of development such as rocking or sucking their thumbs.

Some children are hospitalized for failure to thrive (FTT). Infants and toddlers develop this problem when they don't take in an appropriate amount of nutrition. As a result, the FTT child does not grow as expected for his developmental level. There are many cases of children with FTT who have been hospitalized after spending time in a neglectful home environment where the child does not gain the appropriate amount of weight.

Wearing clothing inappropriate for the climate is an observable indicator of neglect. One example is the child who wears summer clothes in winter (Safe Child Program, n.d.). Other observable indicators include being unwashed and wearing dirty clothing. Neglected children often cry easily, even when they are not severely hurt. They may view themselves as failures and appear to be in their own world. Neglected children may be left alone for long periods of time without any supervision. Lack of ongoing supervision is one of the common causes of death among children.

There are also health indicators of neglect. Children who are always tired or complain of physical symptoms are one example. These children may have untreated medical problems such as not getting glasses or desperately needing dental care.

Malnourishment is another health indicator. Malnourished children gorge on food in quick, large gulps, experience frequent hunger, and may look through garbage cans for something to eat. Indicators of neglect are also evident in the school environment. Neglected children may not have lunch money or come to school without a prepared lunch. Children may arrive to school early and say they do not want to go home. Alternatively, children may often be late or absent from school.

Emotional and psychological abuse. Observable indicators of emotional and psychological abuse include regressive behavior such as rocking, sucking, and biting oneself (Safe Child Program, n.d.). The child who experiences emotional abuse may be extremely aggressive, treat others poorly, and restrict play activities. This child may suffer from sleep problems, difficulties with speech, compulsions, and phobias.

Behavioral indicators of emotional abuse include the child who constantly puts himself down. He may be passive and compliant--willing to please others for attention. Emotional abuse can also cause delays in intellectual and emotional development.

Long-term consequences. Psychological consequences of abuse and neglect can last a lifetime. Depression, anxiety, and suicide attempts are serious problems that can result from abuse or neglect (Silverman, Reinherz, Giaconia, 1996). The insecure early attachment to parents that occurs in an abusive, neglectful environment can lead to relationship problems with peers during adolescence and as an adult (Morrison, Frank, Holland, Kates, 1999). One study found that 33% of maltreated children grow up to abuse or neglect their children, thus continuing the cycle of abuse (Prevent Child Abuse New York, 2003).

Mandated Reporting
All states and the District of Columbia have mandatory child abuse and neglect reporting laws under the Child Abuse Prevention and Treatment Act (CAPTA). Each state has a listing of professionals and organizations that are required to report child abuse and neglect. Mandated reporters include all types of mental health care providers, teachers, school personnel, social workers, all types of health care providers, daycare providers, and law enforcement personnel. Many states mandate that film developers report child pornography practices. Some states require that all citizens report abuse and neglect.

If you suspect that a child in your school or classroom is being abused or neglected, the first step is to talk with your supervisor or school principal. The school should have policies in place to deal with reporting. Some institutions, for instance, discuss suspected incidences of abuse in a team meeting and have a designated individual call CPS. The CPS agency in the state where the abuse occurs is the service that should be contacted. States, not the federal government, have jurisdiction over matters of child abuse and neglect. Each state has specific laws and procedures for investigation and assessment.

Resilience
Much research exists on the prevention of child abuse and neglect (DiScala, Sege, Guohua, Reece, 2000; Hwang, 1999; Newberger Gremy, 2004). While a detailed discussion about prevention efforts are beyond the scope of this chapter, you are encouraged to seek out additional sources about the science of prevention. Resilience is one area of prevention discussed here as it is increasingly viewed as a health promotion intervention strategy.

Resilience has been defined as "the ability to thrive, mature, and increase competence in the face of adverse circumstances or obstacles" (Gordon, 1996, p. 63). It has also been viewed as a "process, capacity or outcome of successful adaptation despite challenges or threatening circumstances…good outcomes despite high risk status, sustained competence under threat and recovery from trauma" (Masten, Best, Garmezy, 1990, p. 426). Given the prevalence of child abuse, resilience is critical for coping as it means children are better able to deal with life circumstances. Better coping is preventive in the sense that children with resilience resources are better equipped to avoid the development of future problems (Kumpfer, 1999).

Much of the traditional resilience research has focused on individual traits or characteristics that contribute to resilience. These traits include easy temperament, secure attachment, basic trust, problem solving abilities, an internal locus of control, an active coping style, enlisting people to help, making friends, acquiring language and reading well, realistic self-esteem, a sense of harmony, a desire to contribute to others, and faith that one's life matters (Davis, 2001).

While this helps us understand individual aspects of resilience, recent research is moving away from this trait-based approach to look at the role of context in positive outcomes for children. Cultural resilience is "a term that considers those aspects of one's cultural background such as cultural values, norms, supports, language, and customs that promote resilience for individuals and communities. Because culture is all around us, because children operate within different cultural mindsets, and because there are inherent values built into these frameworks, we can no longer talk about resilience without incorporating culture and diversity" (Clauss-Ehlers, 2004, p. 36). Resilience as it is defined and practiced must be relevant to a wide spectrum of culturally diverse youth.

The culturally-focused resilient adaptation (CRA) model asserts that culture and sociocultural context influence resilient adaptation (Clauss-Ehlers, 2004). This means that it is important for you to consider not only your student's individual character traits, but also how culture and environment promote resilience. "Culturally-focused resilient adaptation in the face of adversity is defined as a dynamic, interactive process in which the individual negotiates stress through a combination of character traits, cultural background, cultural values, and facilitating factors in the sociocultural environment" (Clauss-Ehlers, 2004, p. 36). Diversity Training Activity 12.3, Building Resilience Across Communities of Youth, is designed to help you understand how resilience processes incorporate culture and diversity.

Diversity Training Activity 12.1
Understanding Different Types of Abuse

Rationale
The purpose of Diversity Training Activity 12.1 is to familiarize you with the different types of abuse. Greater awareness will make you better able to identify warning signs and symptoms associated with abuse and neglect.

Steps to Implementation

1. Write out your definition of child abuse. Include a listing of what you consider to be the different types of child abuse.
2. Your instructor will have participants share their definitions of child abuse.
3. Your instructor will write definitions on the board and begin to differentiate the different types of child abuse.
4. At this point your instructor will formally define the different types of abuse that include: physical abuse, emotional/psychological abuse, sexual abuse, and neglect.

Discussion Points

As you review the different types of child abuse, consider the following questions with the class:

1. What is your reaction to the different types of abuse that children experience?
2. What signs and symptoms indicate that a child in your classroom is experiencing one or more of these types of abuse?
3. How will you deal with a situation where you suspect a child in your class is being abused or neglected?

Diversity Training Activity 12.2

Being a Mandated Reporter

Rationale

As an educator you are required by law to report suspected child abuse. This process is difficult as it is fraught with concern for the child and her family, the outcome of the report (i.e., will the child be placed in foster care), and the influence reporting will have on perceptions of being a trustworthy educator. The purpose of Diversity Training Activity 12.2 is to help you become familiar with the process of mandated reporting. This activity is geared to help you feel less overwhelmed about this responsibility.

Steps to Implementation

1. Your instructor will divide the class into small groups of 5 to 6 students.
2. Discuss the issue of mandated reporting in your groups.

Discussion Points

Consider the following in your group:

1. What concerns do you have about being a mandated reporter?
2. If you found yourself in a situation that you weren't sure required a report or not, what would you do?
3. How do you view your role as a mandated reporter?

Diversity Training Activity 12.3
Building Resilience Across
Communities of Youth

Rationale
The approach to resilience that incorporates culture and diversity examines what works for different people (Lopez et al., 2002). By looking at the different supports and protective factors that effectively promote resilience processes, the hope is that you will have greater understanding about what fosters resilience for diverse racial/ethnic youth. This awareness is critical as we think about shifting the paradigm of psychological practice from one traditionally focused on disease to one that promotes health.

Steps to Implementation

1. Read chapters 4, 5, 6, and 7 in the book Community Planning to Foster Resilience in Children (Clauss-Ehlers Weist, 2004). Each chapter focuses on a different racial/ethnic group as follows: Chapter 4 Sacred Spaces: The Role of Context in American Indian Youth Development (LaFromboise Medoff, 2004); Chapter 5 Risk and Resilience in Latino Youth (Javier Camacho-Gingerich, 2004); Chapter 6 Building Strengths in Inner City African-American Children: The Task and Promise of Schools (LaGrange, 2004); and Chapter 7 Resilience in the Asian Context (Wong, 2004).
2. Your instructor will divide the class into four groups and assign a chapter to each.
3. As you review the chapter in your group consider the following:
a. What are some of the within-group differences for this group of youth?
b. What are the sociocultural stressors faced by this group of youth?
c. What coping mechanisms are described for this group of youth?
d. How do resilience processes play out for this group of youth?
4. Prepare a 20-minute presentation for the class that incorporates your responses to the aforementioned questions and present your presentation to the class.

Discussion Points

Consider the following in your discussion:

1. What do the different presentations suggest about cultural aspects of resilience?
2. What similarities and differences exist between the presentations?
3. How will you promote resilience in your classroom?

Notebook Section for Chapter 12

Child abuse and resilience

I. CONCEPTS/THEORIES

II. CLASSROOM OBJECTIVES

III. BEST PRACTICES (HOW TO IMPLEMENT THOSE OBJECTIVES IN THE CLASSROOM)

Web Resources­­

The has a website that describes different types of abuse. The website talks about the prevention of sexual, emotional, and physical abuse as well as safety around strangers.

The U.S. Department of Health and Human Services Administration for Children and Families provides statistics on child maltreatment, a list of fact sheets, and information about laws, policies, and child welfare reviews.

References
Clauss-Ehlers, C.S. (2004). Re-inventing resilience: A model of "culturally-focused resilient adaptation". In C.S. Clauss-Ehlers M.D. Weist (Eds.), Community planning to foster resilience in children (pp.27-41). New York, NY: Kluwer Academic Publishers.
Clauss-Ehlers, C.S., Weist, M.D. (Eds.). (2004). Community planning to foster resilience in children. New York, NY: Kluwer Academic Publishers.
Conway, E.E. (1998). Nonaccidental head injury in infants: The shaken baby syndrome revisited. Pediatric Annals, 27(10), 677-690.
Davis, N.J. (2001). Resilience in childhood and adolescence. Panel presentation delivered at George Washington University, Media Conference, Washington, DC, April.
DiScala, C., Sege, R., Guohua, L., Reece, R. (2000). Child abuse and unintentional injuries: A 10-year retrospective. Archives of Pediatric Adolescent Medicine, 154, 16-22.
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Copyright 2006. Used with permission from Springer Publishers.